The initial idea for the project was developed by Mr. Patrick Kreuz,a member of the Embassy of the Federal Republic of Germany to Mongolia. During heavy rainfalls in the summer of 2009 lots of the remote areas – the so-called ger-districts - of Mongolias capital Ulaanbaatar where effected buy a flood, which destroyed lots of gers (Mongolian traditional housing tents) and submerged lots of the latrines, dug into the ground by the population of those ger-districts.

After reports by the embassies of Germany and France both governments decided to jointly donate some humanitarian relief aid to those people in need, assisting them to overcome this critical situation. Mr. Kreuz contacted his former employer, a pharmacist from his home-town, and asked for possible donations of hygienic equipment, which was supposed to be delivered to the medical care units which had to ensure the medical treatment of the people of those affected areas.

With the support of Dr. Altannavch Tsevegjav, UN Dispensary, those received donations were distributed to different health care units.

It was obvious that there was a much higher demand by the health care workers to handle hygiene matters in a different way. Mr. Kreuz therefore contacted Prof. Dr. Popp, head of the hospital hygiene department of the University Clinics of the City of Essen, Germany to figure out if there could be a possible collaboration. After presenting the idea and discussing possible goals a first fact finding mission was initiated in June of 2010.

Prof. Dr. Popp was joined by Prof. Baum (University Hospitals Ulm) as well as Mr. Thomas Lembeck and Jörg Spors from the Essen Fire Department.

Several meetings with – for example the WHO Country Office Mongolia, the Ministry of Health and the National Emergency Management Agency were organized. Also the group visited the National Central Hospital, the Chingeltei District Health Unit, the National Center of Communicable Diseases (NCCD), the School of Public Health, the Emergency Medical Service - 103 and the Ulaanbaatar Emergency Management Department.

After the visit following conclusions had been established:

• The existing micro-biologic diagnostic is not sufficient.
• The situation of multi-resistant bacteria is unclear.
• The mandatory reporting of nosocomial infections shows not clear infection rates. (A nosocomial infection rate of 5.4 % - according to a study published in 2010 by Australian doctors could be realistic)
• Mongolia is a part of WHO program “Clean care is safer care”. Unfortunately alcoholic hand-rub is not available in most government operated hospitals.
• The general health expenditures in Mongolia are lower compaired to other Western countries.
• There is high rate of antibiotics use and availability at pharmacies without prescriptions.
• There is a high prevalence of hepatitis carriers in Mongolia, but a low vaccination rate even in healthcare workers.
• Reprocessing of medical devices is old-fashioned and there a critical deficits regarding some devices.
• Similar problems as in hospitals were seen in Emergency Service 103.

The German delegation together with their Mongolian counterparts developed a project to strengthen hygiene in National Central Hospital, Chingeltei District Health Unit and Emergency Service 103. This project got support from both Federal Ministry for Health, Germany and Ministry of Health of Mongolia, based on their agreement on co-operation in the field of health. Thus, the project was established as Mongolian Emergency Service and Hospital Hygiene Project (MeshHp).